治疗烧伤创面不宜使用磺胺嘧啶银(SSD)

在另一篇Brölmann引用的系统评述[5]中，鉴别出26项随机对照临床试验（共计2066患者）。由于治疗方法和效果的异质性，没有做荟萃分析，而是按创伤类型和银制剂将结果分组总结。而在感染率、伤口愈合率、疼痛和费用方面的比较研究都得出明显不利于SSD的结果，其相关结论为“没有证据支持使用SSD预防非全层皮肤烧伤患者的伤口感染。与其他含银及非银敷料相比，没有临床试验表明SSD在其他疗效上有益。而且，有证据表明SSD可能延缓伤口愈合，花费更贵以及用于烧伤时病人更疼痛”。
In another systematic review [5] cited by Brölmann, 26 RCTs (2066 patients) were identified. Due to the heterogeneity of treatments and outcomes precluded meta-analysis, they grouped results according to wound type and silver preparation. The comparisons in terms of infection rate, wound healing rate, pain, and costs showed statistically significant differences in favour of non-silver dressing against SSD with conclusions that “ there was no evidence to support the use of silver sulphadiazine (SSD) for prevention of wound infection in patients with partial-thickness burns. None of the trials indicated a beneficial effect for SSD for other outcomes when compared with other silver-containing or non-silver dressings. Furthermore, there was evidence that SSD may delay wound healing, may be more expensive, and may be more painful when applied to burns.”

第二篇系统评述是Aziz等人[2]在国际烧伤学会的烧伤杂志上发表的，他们想通过对已有证据的荟萃分析，评价在烧伤中含银的敷料和局部药物对于预防感染和促进愈合的作用效果。他们鉴别出14项随机对照临床试验，涉及877名患者。其结果表明“与非银组相比，局部银制剂显示出明显更差的愈合时间，并且没有显示出有效预防伤口感染的证据”。他们的评述揭示了“含银敷料和局部银制剂比对照敷料在预防烧伤感染和促进烧伤愈合上更差或者不会更好”。
In the second systematic review article, published on Burns[2], Aziz et al. aimed to evaluate the effectiveness of silver containing dressings and topical silver for preventing infection and promoting healing in burns wounds through a meta-analysis of the available evidence. They identified 14 RCTs involving 877 participants. Their results indicated that “topical silver showed significantly worse healing time compared to the non-silver group and showed no evidence of effectiveness in preventing wounds infection”. Their review suggests that “silver-containing dressings and topical silver were either no better or worse than control dressings in preventing wound infection and promoting healing of burn wounds”.

另外，SSD对皮肤细胞有毒[6]，倾向于粘附在伤口表明并且需要经常换药因而损伤新生上皮延缓伤口愈合[6]。有确凿证据表明，应用了含银药物制剂后银离子被吸收入体循环并从尿中排泄。研究表明磺胺嘧啶银中释放的银离子在角化细胞、肝细胞、中性粒细胞、白细胞以及成纤维细胞中是有毒性的并与细胞特征的丧失有关[8, 9]。受损的人角化细胞表现出的退行性病变可能导致创伤处上皮再生的延迟。而且，长期暴露于银离子的细菌产生了对银的抗药性。依据细菌对抗菌剂的性质，在选择压力下增殖的细菌可能出现固有的和获得性的抗药机制。临床证据已发现死于感染的患者的烧伤部位具有银抵抗的菌株。
In addition, SSD has toxic effect on skin cells [6] and tends to adhere to wound surface and requires frequent dressing changes which would hurt newly generated epithelium and delayed wound healing [7]. Irrefutable evidence has shown that silver is absorbed into the systemic circulation and excreted in urine after application of silver-containing pharmaceutical preparation. Study has shown that silver released from SSD was toxic in keratinocyte, hepatocyte, neutrophils, leucocyte and fibroblast and was association with a loss in cellular identity [8, 9]. One of the possible outcome of human keratiocytes is degenerative changes which lead to actual “delay” of wound re-epithelialisation. Furthermore, one consideration has been implicated in bacteria after long time exposure to silver, the consequential bacterial resistance to silver [10] .
According to the nature of bacteria toward antimicrobial agent, intrinsic and acquired mechanism may emerge as bacteria proliferate under selective pressure. Clinical evidence has found patients who died from infection contained silver resistant strain of bacteria at their burn wound.

对PubMed就“磺胺嘧啶银对烧伤之效果的系统评述”进行快速搜索，获得两篇相关的文章，结果都不利于SSD。 其中Wasiak等人[11]的评述观点是“SSD霜可能无效或有害”以及“相比于其他治疗，SSD霜可能延长愈合时间并增加疼痛”。另一篇Andrew等人[12]的文章只鉴别出了7个动物实验且结果相互矛盾。
A quick search in PubMed for “systematic review on the effectiveness of silver sulphadiazine on burns” retrieved two relevant articles, both of which are not in favor of SSD. The review by Wasiak et al. [11] got the view of “ likely to be ineffective or harmful” for SSD cream and that “Silver sulfadiazine cream may prolong healing times and increase pain compared with other treatments”. The other article by Andrew et al. [12] identified only 7 animal studies providing conflicting results.